(Section 5(6))

I ............................................................................ (AB), do hereby solemnly declare that I will be loyal to the Republic of South Africa, promote all that will advance it and oppose all that may harm it, uphold and respect its Constitution and commit myself to the furtherance of the ideals and principles contained therein.

Signed at ....................................................................................on this.................day of ................ (month), 19....

......................

SIGNATURE

In the presence of the following two witnesses who are South African citizens.

1..................................... (WITNESS)

2..................................... (WITNESS)